Modelling social determinants of self-evaluated health of poor older people in a middle-income developing nation

Abstract

Over the last 2 decades (1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), poverty in Jamaica has fallen by 67.5%, and this is within the context of a 194.7% increase in inflation for 2007 over 2006. It does not abate there, as Jamaicans are reporting more health conditions in a 4-week period (15.5% in 2007) and at the same time this corresponds to a decline in the percentage of people seeking medical care. Older people's health status is of increasing concern, given the high rates of prostate cancer, genitourinary disorders, hypertension, diabetes mellitus and the presence of risk factors such as smoking. Yet, there is a dearth of studies on the health status of older people in the two poor quintiles. This study examined 1) the health status of those elderly Jamaicans who were in the two poor quintiles and 2) factors that are associated with their health status. A sample of 1,149 elderly respondents, with an average age of 72.6 years (SD = 8.7 years) were extracted from a total survey of 25,018 Jamaicans. The initial survey sample was selected from a stratified probability sampling frame of Jamaicans. An administered questionnaire was used to collect the data. Descriptive statistics were used to examine background information on the sample, and stepwise logistic regression was used to ascertain the factors which are associated with health status. The health status of older poor people was influenced by 6 factors, and those factors accounted for 26.6% of the variability in health status: Health insurance coverage (OR = 13.90; 95% CI: 7.98-24.19), age of respondents (OR = 7.98; 95% CI: 1.02-1.06), and secondary level education (OR=1.82; 95% CI: 1.35-2.45). Males are less likely to report good health status than females (OR = 0.56; 95% CI: 0.42-0.75). Older people in Jamaica do not purchase health insurance coverage as a preventative measure but as a curative measure. Health insurance coverage in this study does not indicate good health but is a proxy of poor health status. The demand of the health services in Jamaica in the future must be geared towards a particular age cohort and certain health conditions, and not only to the general population, as the social determinants which give rise to inequities are not the same, even among the same age cohort.

The Epidemic of Non-communicable Diseases in Jamaica: Monsters Awoken from Lifestyle Practices

“…Using data for 2008 for Jamaica, we can compute the probability of deaths due to CNCDs for the elderly. The probability of deaths caused by CNCDs for those 60+ years old is 0.307% or 30.7% (0.499 × 0.615), which is relatively close to the percentage of those 60+ years old who died because of CNCDs (42%) in low-to middle income countries [22]. With the absence of data on causes of deaths disaggregated by age this research is unable to compare for Jamaica against the Americas.…”

“…Smith and Menah [18] attribute deaths, because of CNCDs, to urbanization, sedentary lifestyle, global marketing of tobacco and food, and population aging. Shao [22] opines that 16% of global deaths results from CNCDS, occurred before 60 years and that 42% of deaths, due to CNCDS, occurred in low-to middle-income countries and this emphasizes the age disparity in those conditions, which is also the case in Jamaica. Using the perspective that CNCDs are owing to lifestyle practices including physical activity (or the lack of), tobacco and food consumption, the finding of the present study's about the disparity in CNCDs between the age cohorts can be explained by the lifestyle practices of Jamaicans.…”

Unspecified Non-communicable Diseases in Jamaica: Has the Time Come to Unravel this Label?

“…A plethora of studies on social determinants of health are in the literature; [36][37][38][39][40][41][42][43][44][45][46] however, none showed two social determinants of health of those with unspecified NCDs except the present one. Even studies in Jamaica, as well as one in Barbados, on the population and sub-populations showed many social determinants of health [36][37][38][39][40]46]. Using good health status to examine the social determinants of health, Bourne found that many factors explained health status of the population over their life course including age and area of residence.…”

“…The literature provided pertinent information that those with chronic non-communicable diseases are female [26], reside in low-tomiddle income countries [2,3,27], rural residents [6,11], elderly population [6][7][8]28,29], and that the Caribbean region has the highest rate of deaths due to NCDs in the Americas [1]. In fact, Jamaica is shown to have a high prevalence of hypertension and diabetes, however, to know the types of NCDs will better aid the management of these conditions.…”

“…This demonstrates the health challenge of governments, public health specialists, health care practitioners and other people to address the matter of NCDs. Jamaica, a country in the English-speaking Caribbean region, experienced an increase in NCDs and there is also a change in the identity of those that are faced with these conditions over the last ten years [6][7][8][9][10][11]. This reality is captured in a study conducted by Bourne et al [7] that the rate of NCDs in Jamaica increased from 8 per 1,000 in 2002 to 56 per 1,000 in 2007.…”